Form 5 - Operations Report - Expenditure on …

1 Form 5 WESTERN AUSTRALIA mining Act 1978 (Secs. 51, 68, 70H, 82 and 115A) (Regs. 16, 22, 23E, 32, 96B and 96C) Operations Report Expenditure ON mining tenement (To be completed in accordance with instructions) Annual: Final: tenement Type: Number : / Reporting Period: From: / / To: / / MINERAL-EXPLORATION AND/OR mining ACTIVITIES Itemize activities and Expenditure on Attachment 1 A. MINERAL-EXPLORATION ACTIVITIES: $ B. mining ACTIVITIES: $ Evidence of lodgement to be provided C. ABORIGINAL HERITAGE SURVEYS: $ D. ANNUAL tenement RENT AND RATES: $ E.

2 ADMINISTRATION/OVERHEADS: $ F. (OTHER) LAND ACCESS/NATIVE TITLE COSTS: Jointly not to exceed 20% of the minimum commitment or Expenditure on the activities shown above, whichever is the greater (see instructions). $ $ TOTAL Expenditure : $ Full details and results of mineral-exploration activities must be submitted in the annual mineral-exploration Report in accordance with section 115A of the Act and the guidelines published under regulation 96B. OR Itemize activities and Expenditure on Attachment 2 PROSPECTING AND/OR SMALL SCALE mining ACTIVITIES TOTAL Expenditure : $ (A to E ON ATTACHMENT 2) A copy of this page of the Operations Report and Attachment 1 titled Summary of Mineral-Exploration and/or mining Activities or Attachment 2 titled Summary of Prospecting and/or Small Scale mining Activities may be obtained by any person on the payment of the prescribed fee in accordance with regulation 96(3).

3 Full name and address of holder/s. NAME: ADDRESS: Full name and address of operator/ manager (if mining tenement under option or joint venture). NAME: ADDRESS: List here details of the related annual mineral-exploration Report . Mineral-exploration Report (for single tenement ) Title: Combined mineral-exploration Report (for group of two or more tenements) Title: Combined reporting number for tenement group: C / Combined reporting date for group: / / I certify that the information on pages 1 and 2 and in Attachment 1 Summary of Mineral-Exploration and/or mining Activities or Attachment 2 Summary of Prospecting and/or Small Scale mining Activities constitutes a true statement of the Operations carried out and monies expended on this mining tenement during the reporting period specified.

4 Signature of holder or agent (if agent, full name and address of agent) Date: / / (Tick appropriate box and show Expenditure . If more than one commodity sought, tick appropriate boxes and allocate Expenditure for each one). MINERAL COMMODITY SOUGHT ON tenement Gold $ Diamond $ Iron ore $ Mineral Sands $ Nickel/Cobalt $ Other (specify) $ Copper/Lead/ Zinc/Silver $ .. This page is not to be copied in conjunction with regulation 96(3). Note: ATTACHMENT 1 SUMMARY OF MINERAL-EXPLORATION AND/OR mining ACTIVITIES OR ATTACHMENT 2 SUMMARY OF PROSPECTING AND/OR SMALL SCALE mining ACTIVITIES HEAD OFFICE USE This Operations Report received (A) The attachments to the Form 5 are to provide a summary of the activities carried out and the cost of each activity.

5 For Attachment 1 you may either use the pro-forma sheet or a separate sheet with the suggested headings as shown under 4(A) and (B) in the instructions. For Attachment 2 the pro-forma sheet available from the Department must be used. (B) A copy of Attachment 1 or 2 will be provided together with a copy of the front page of the Form 5 to any person on payment of the prescribed fee. INSTRUCTIONS FOR THE COMPLETION OF FORM 5 1. The Form 5 Operations Report and mineral exploration Report are required to be lodged annually for each mining tenement within sixty (60) days from the anniversary or surrender date of the mining tenement (or such further period as may be approved by the Minister prior to the expiry of that period).

6 These reports should be lodged at any mining registrar s office. A mineral exploration Report is not required if the general prospecting activities detailed in Attachment 2 are the only activities carried out. 2. The Form 5 and attachments must show Expenditure incurred on the activities undertaken during the annual period of the mining tenement or the period up to surrender and may be varied according to the type of activities undertaken (a) for mineral-exploration and/or mining activities (see 3 below); and/or (b) for general prospecting and/or small scale mining activities (see 4 below). 3. For mineral-exploration and/or mining activities, the format of the Form 5 consists of the two pages (as shown on this form) plus Attachment 1 to provide details of the cost and description for each activity (see A and B below for examples of the activities to be shown).

7 The full cost of Aboriginal heritage surveys is allowed (see C below). Administration/overheads/land access/native title costs are not to exceed 20% of the minimum Expenditure commitment, or the total of Expenditure incurred on activities, whichever is the greater (see E and F below for the costs that can be claimed). Full details and results of mineral-exploration activities are required to be submitted in a mineral-exploration Report (see 6 to 8 below). 4. For all other general prospecting activities ( non-geoscientific activities such as metal-detecting, loaming, panning, dollying, dry-blowing, trenching, plant and equipment hire, own labour costs) the format of the Form 5 consists of the two pages (as shown on this form) plus Attachment 2 to provide details of prospecting and/or small scale mining activities.

8 A. MINERAL EXPLORATION ACTIVITIES Geological activities: geological mapping, sampling, drilling supervision, core logging, non-core drill-sample logging, geological data processing and interpretation, petrology, planning of exploration programs, Report preparation; where appropriate, general prospecting can be added here. Geochemical activities: geochemical sampling, analysis of surface geochemical samples or subsurface drilling samples, geochemical data processing and interpretation. ALSO show number of samples collected. Geophysical activities (surface/subsurface): ground geophysical surveys, downhole logging, geophysical data processing and interpretation.

9 Airborne geophysical activities: aerial survey costs, geophysical data processing and interpretation. Remote sensing activities: aerial photography, remote sensing images, photo interpretation, image processing and interpretation. Mineralogical activities (exploration for diamonds, heavy mineral sands, etc.): bulk sampling, mineral separation, mineralogy and analysis of diamond indicator minerals or other minerals. Surveying activities: gridding, line clearing, grid tie-in, tenement boundaries, etc. Core drilling: diamond drilling costs (including pre-collar open-hole non-core drilling), access road and drill-site preparation; ALSO show metres drilled and number of holes completed.

10 Non-core drilling: drilling costs, access road preparation; ALSO show metres drilled and number of holes completed. Costs for deep geochemical sampling by auger or air-core drilling can also be shown here. ( Specify drilling for groundwater supply.) Costeaning: plant and equipment hire for trenching and bulk sampling. Field supplies: exploration equipment, consumables and supplies, plant and equipment hire, fuel, oil, etc., depreciation of direct exploration equipment, wages for non-professional field personnel. Drafting activities: drafting equipment, consumables and supplies, salaries for drafting personnel. Travel: travel costs directly associated with mineral exploration activities conducted on the tenement .